Opening Doors to Universal Access

The International Center for Research on Women (ICRW) is conducting a study to better understand the barriers Indian women in certain settings encounter when accessing HIV prevention, treatment and support services.

As part of the U.N. Development Programme’s (UNDP) “Universal Access for Women and Girls Now! (UA Now!)” initiative, the ICRW study focuses on female sex workers in Pune, a district in the state of Maharashtra; and the wives of migrant workers in Ganjam, Orissa. Both are vulnerable, high-risk populations in which HIV is very prevalent. And while several studies exist about female sex workers – including by ICRW – none has comprehensively analyzed the barriers women sex workers face in accessing HIV-related services. Meanwhile, there has never been an examination of the vulnerability and risk to HIV among wives of migrant men.

UA Now! aims to improve and expand HIV services for women and girls. The initiative supports countries in developing national action plans that address gaps in efforts to respond to the HIV epidemic and ensures that those responses reflect the specific needs of women and girls.

Along with India, UA Now! also is being implemented in Ethiopia, Kenya, Madagascar, Malawi, Namibia, Rwanda, Zambia, Tanzania and Swaziland. While there are common causes, risk factors and consequences related to women and HIV globally, each country has its own unique structural and cultural implications.

“Women worldwide are disproportionately affected by HIV and continue to have limited access to the services available to them,” said Priya Nanda, UA Now! project director and group director of social and economic development at ICRW’s Asia Regional Office in New Delhi. “What is still not fully understood in India, however, is the range of perceived and actual barriers to HIV prevention, treatment, care and support – particularly for women. We’re working to identify evidence-based, context-specific approaches to effectively address this.”

ICRW will use its research findings to work with India’s National AIDS Control Organisation (NACO) in its creation of an action plan to respond to the epidemic. ICRW also will make recommendations to NACO on how to help women overcome structural, social and cultural barriers to health services. NACO’s targeted intervention strategy primarily addresses high risk groups, which include female sex workers.

“Services should be accessible, affordable and acceptable, and the data on use and access needs to be systematically collected to make the system accountable,” Nanda said. “That’s the only way we can determine whether universal goals are being met.”

By achieving universal access to HIV-related services, countries can gain a significant leg up on broader health and development goals, such as alleviating poverty, reducing maternal mortality rates and creating more equitable societies, according to UNAIDS. UA Now! builds upon U.N. member state commitments to universal access and the Millennium Development Goals promoting gender equality, empowering women and combating HIV and other diseases by 2015.

In India’s case, women make up 39 percent of the approximately 2.9 million people living with HIV. According to NACO data, most women in monogamous relationships are infected by their husbands, but among all women, HIV remains most prevalent among women in sex work. Nanda said that other aspects of women’s risk and vulnerability to HIV are considerably under-researched and unknown.

As part of the UA Now! study, ICRW experts spoke to sex workers and wives of migrant men to understand their experiences when seeking HIV-related services. ICRW also interviewed service providers, government officials and male partners of the women in the study.

Early findings among female sex workers show that:

• Women in sex work report high levels of stigma themselves, making them reluctant to openly seek HIV services.
• They report that service providers do not honor their privacy and don’t keep confidential women’s health information.
• They fear knowing their HIV status, and how that could affect their earning potential.
• While a high proportion of sex workers seek HIV testing services through non-governmental organization clinics, their knowledge of HIV treatment is starkly low.

And early findings among women married to migrant men show that:

• Very few know anything about HIV risk; they trust their husbands.
• Transportation costs to a health provider are prohibitively high, so wives of migrant men are less likely to seek care.
• Few health centers are available in the area, especially with female counselors.
• Families with an HIV-positive person face stigma and discrimination from their extended families and communities.

ICRW’s complete findings are scheduled to be available in March 2011. 

Gillian Gaynair is ICRW’s writer/editor.